Ambulatory blood pressure monitoring in acute stroke - The West Birmingham Stroke Project

Background and Purpose Ambulatory blood pressure monitoring (ABPM) devices are increasingly used in the assessment of hypertension, but their value in patients after a stroke is unknown, despite the fact that hypertension is an important cause of stroke and many patients have relatively high blood pressure (BP) levels at presentation. We therefore investigated the clinical use of a 24-hour oscillometric ABPM device in patients' after acute stroke. We also investigated ABPM in different types of stroke (thrombosis, hemorrhage, and transient ischemic attack) and ethnic and sex differences. Methods BP was measured manually with a standard mercury sphygmomanometer, and ABPM measurements were made with an oscillometric device. The first reading obtained with the ABPM device was compared with simultaneous manual BP measurements. Mean daytime and nighttime pressures were also analyzed to determine the frequency of nocturnal BP falls (''dipping''). Results We studied 86 patients (48 men; mean +/- SD age, 64.2 +/-9.2 years) admitted with acute-onset stroke (ictus within 12 hours) in a district general hospital. Thirty-one patients (36.0%) had a previous history of hypertension. The median percentage of successful BP readings by ABPM was 92% (interquartile range, 72 to 98). There was no significant difference in manual BP levels compared with the first simultaneous systolic or diastolic ABPM measurements. Systolic BPs recorded by ABPM were significantly higher in black patients with acute stroke and in patients with intracerebral hemorrhage, who also showed a trend toward higher nocturnal BPs. There was no difference in BPs between men and women and those who were alive or dead 6 months later (P=NS). There was also no difference between mean day and night systolic BP (mean difference, 1.9 mm Hg; P=.08), although mean daytime diastolic BP was higher than mean nighttime diastolic BP (mean difference, 2.4 mm Hg; P=.01). Patients with stroke therefore demonstrated a loss of diurnal BP rhythm and may be considered ''nondippers''; there was also a trend toward ''reverse dipping'' in patients with intracranial hemorrhage. Conclusions This study demonstrates higher systolic BPs as recorded by ABPM (but not manually) in patients with intracerebral hemorrhage than in those with cerebral infarcts; higher levels were also found in blacks. ABPM recordings are useful in the assessment of BP in patients with stroke, who may be considered nondippers.